Day 2 :
University Campus Bio Medico of Rome, Italy
Time : 09:00-09:45
Prof Michele Cicala, MD, has completed his PhD and postdoctoral studies at the age of 30 years from University Sapienza of Rome. He is responsible for the Unit of Gastroenterology and Digestive Endoscopy and head of the postgraduate course of University Campus Bio Medico of Rome, Italy. He has published more than 90 papers in reputed journals and has been serving as an editorial board member of repute.
Gastro-esophageal reflux disease (GERD) is a highly prevalent condition (affecting up to 20% of subjects in Western populations) which significantly impacts the daily quality of life. GERD encompasses a heterogenous group of manifestations, with esophageal and/or extra-esophageal symptoms, ranging from complicated phenotypes such as erosive esophagitis and Barrett’s esophagus to the “non-erosive” symptomatic disease. The pathophysiology of non-erosive disease is incompletely understood. Diagnostic work-up and treatment may be challenging when patients are incorrectly classified. Beside upper endoscopy, direct reflux tests such as ambulatory esophageal pH-metry or, more recently, pH-impedance monitoring allow an accurate classification of conditions presenting with esophageal symptoms without endoscopic abnormalities. Findings of reflux testing, essentially esophageal acid exposure time and temporal association between symptoms and reflux events, are able to discriminate patients with a true non-erosive disease - displaying a pathological reflux - from patients affected by hypersensitivity to a physiological reflux and from patients affected by functional heartburn (FH), the latter defined as a functional esophageal disorder characterized by chronic heartburn unrelated to acid or nonacid reflux. In FH patients symptoms persist despite PPIs and are considered to be strongly associated with peripheral or central sensitization. This new classification, recently adopted by international groups of experts - the Rome foundation for functional GI disorders and GERD international group - might provide a better support to different therapeutical approaches. There is still a great unmet clinical need for therapeutic drugs that can be used to treat FH, and the development of novel drugs, diagnostic tests and biomarkers is eagerly awaited.
University of Munich, Germany
Keynote: Long-term quality of life of patients with permanent end ileostomy: Results of a nationwide cross-sectional survey
Time : 09:45-10:30
After finishing medical school Dr. Kasparek began his clinical and academic career at the Department of Surgery at the University of Tuebingen / Germany in 2001. His research focused on postoperative ileus and fast track surgery as well as on quality of life in patients with colorectal cancer and chronic inflammatory bowel disease. From 2005 to 2007 he spent a two-years research fellowship at the Gastrointestinal Research Unit at the Mayo Clinic Rochester, MN, USA exploring alterations in neuromuscular innervation of the gastrointestinal tract in different diseases in animal models. Furthermore, he conducted several quality of life studies in rectal cancer patients during this time. After coming back to Germany in 2007 he continued his clinical and scientific work at the Department of Surgery at the University of Munich, Germany. With funding from the German government, he built up his own laboratory and research group and explored changes in neuromuscular innervation during postoperative ileus and aging in animal models. His clinical research focused again on quality of life and gastrointestinal function of patient with colorectal cancer, ostomy patients, and patients with inflammatory bowel disease.
In 2015 Dr. Kasparek became the head of the Department of Surgery of the Klinik Josephinum in Munich, Germany and continues his scientific work in collaboration with the University of Munich.
Background: Patients with permanent end ileostomy are at high risk for detrimental stomal effects on their quality of life (QoL). However, there are little data regarding long-term QoL in these patients.
Objective: To assess long-term QoL in patients with permanent end ileostomy.
Data Sources and Study Selection: A cross-sectional survey of 1,434 patients with permanent end ileostomy registered at the German self-help organization, ILCO.
Main Outcome Measures: Assessment of QoL was performed according to the Short Form (SF-)36, including physical (PCS) and mental component summary (MCS) scores, Gastrointestinal Quality of Life Index (GIQLI), and the Cleveland Global Quality of Life Index (CGQLI). Multivariate risk factor analysis was performed.
Results: A total of 783 responders were included. The indications for ileostomy included ulcerative colitis (44%), Crohn’s disease (38%), and colorectal cancer (7%). Adverse effects in daily life due to stoma were reported by 72% of participants. QoL was significantly impaired compared to the general population on all summary scores and several subscales (PCS: 44.6±10.4 (Mean±SD) vs. 50.2±10.2, P<0.001; MCS: 47.5±10.7 vs. 51.5±10.2, P<0.001; GIQLI: 94.4±16.4 vs. 126.0, P<0.001). Stoma care problems were reported by 63% of respondents to affect QoL, including parastomal hernia (P<0.001), stenosis (P=0.003), and prolapse (P=0.0078). Vitamin-B12, iron, and zinc deficiencies were also associated with diminished QoL, with vitamin-B12-deficiency particularly associated with reduced mental and emotional QoL. The profound negative effect of stoma care problems and deficiencies was confirmed by multivariate analysis.
Conclusions: QoL was markedly impaired in patients with permanent end ileostomy compared to the general population. The main reasons were stoma-associated morbidity and deficiency syndromes. These findings emphasize the importance of prevention, screening, and adequate treatment.
S M S Medical College and Hospital, India
Keynote: Single incision trans-umbilical laparoscopic cholecystectomy using conventional laparoscopic instruments - An experience of 500 cases
Time : 10:30-11:15
Dr Lakshman Agarwal is a Senior Professor and ex-Head of Department of Surgery in S.M.S Medical College and Hospital, Jaipur, India. He has more than 25 years of surgical experience in Gastrointestinal surgeries. He specializes in advanced laparoscopic procedures with 13+ years of experience, consulting 100+ cases and operating 50+ cases per week pertaining to GI related problems. He holds an M.B.B.S and M.S (Gold Medal) from S.M.S Medical College, Jaipur.
Cholecystectomy is considered the gold standard surgery for cases of cholelithiasis. Since the first successful laparoscopic cholecystectomy was performed in 1987, there has been a trend toward minimizing the required number and size of ports from four to three and finally a single port to reduce abdominal wall trauma, postoperative pain and yield better cosmetic results.
We report our experiences from study of 500 cases of single insicion laparoscopic cholecystectomy by Transfacial technique using conventional instruments. The study was undertaken at a tertiary care hospital over three years of 500 patients of USG proven cholelithiasis in a single surgery unit by a single operator. The study included all cases above 14 years, male to female ratio of patients in was 1:10 and exclusion criterion were same as for conventional cholecystectomy.
The procedure was performed using a trans umblical incision of size 2 - 2.5 cms with two 5mm subfacial stabs for working ports and one 10mm stab for camera. An anterior axillary line minigrasper was used when required.
The mean operative time was 30 min (range: 22–45 min). Four of the cases were subjected to open cholecystectomy as calot triangle was frozen. There was cystic artery bleed in three cases which was taken care of using harmonic. There was slipping of clip in post operative period in two cases which was managed by ercp stenting. 435 patients discharged on the 1st postoperative day and 65 patients (13.33%) discharged on the 2nd postoperative day. The average wound length measured on 3rd postoperative day in follow up was 2 cm (range1.3–2.1 mm); while average score of patient satisfaction of the surgery was of 9.32 (range 7–10).
We concluded that in uncomplicated gall bladder disease, single incision laparoscopic cholecystectomy is feasible and safe with excellent cosmetic results and high grade of patient satisfaction and can be performed with the conventional laparoscopic instruments with adequate experience.